tag:blogger.com,1999:blog-18943510.post4418741161927401965..comments2015-03-02T19:14:50.760-06:00Comments on Dr. Wes: Pacemakers and CERT AuditsDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-18943510.post-48355288932660424392011-02-28T21:31:53.793-06:002011-02-28T21:31:53.793-06:00Thor-
Currently, Medicare uses 2005 recommendatio...Thor-<br /><br />Currently, Medicare uses 2005 recommendations for ICD implantation which were superseded by 2008 guidelines long ago (it&#39;s now 2011). This, regrettably, should place physicians on notice that the when government cost-cuts are needed there will be little incentive to adapt guidelines to new knowledge or doctor input, unless of course, the new recommendations limit DrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-49571583420610705482011-02-28T10:44:31.578-06:002011-02-28T10:44:31.578-06:00Just got hit with the dual chamber audit. CMS is u...Just got hit with the dual chamber audit. CMS is using 1985 guidelines for this audit! In your experience/opinion, do I have any realistic chance of being reimbursed for those 50 pacemakers (or at least getting paid for a single chamber pacer instead of no payment)? Of course these were all appropriately indicated 2 ch PPMs.Thorhttp://www.blogger.com/profile/04643018454741692556noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-2211446517812043062010-04-05T14:28:26.636-05:002010-04-05T14:28:26.636-05:00plus the approved indication for scd-heft was for ...plus the approved indication for scd-heft was for single chamber devices. no additional payment for dual chamber icd&#39;s. yet plenty of dual chamber icd&#39;s going in, suggesting that physicians believe that the second lead will help (no additional payment for it, additional cost to hospital incurred, additional liability to physician).<br />of course keith might argue that those were Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-78642887217638878042010-04-05T13:58:44.415-05:002010-04-05T13:58:44.415-05:00Bob-
Isn&#39;t this where the pre-existing condi...Bob-<br /><br /><i> Isn&#39;t this where the pre-existing condition (or cure) is a benefit?</i><br /><br />All that happens with CERT audits is they note an increase in Medicare billing codes, so this triggers an audit. The very fact that new indications for pacing (like congestive heart failure in patients with poor EF and LBBB) have arisen since the criteria in 1996-2002 were established meansDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-36199948908866198852010-04-05T12:09:10.416-05:002010-04-05T12:09:10.416-05:00I would suggest to you that it is the willingness ...I would suggest to you that it is the willingness of some of your colleugues to put dual chamber pacemekers in every patient, regardless of the need or not, that is driving up the costs to Medicare and other insurers, and ultimately the patients, that brings about these onerous rules. <br /><br />Are we to be so naive to imagine that indications for this expensive technology is not being Keithnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-37429963626133618692010-04-05T10:49:06.720-05:002010-04-05T10:49:06.720-05:00Glad I got all three leads in before I reached med...Glad I got all three leads in before I reached medicare age. Isn&#39;t this where the pre-existing condition (or cure) is a benefit?Bobhttp://www.blogger.com/profile/14313050416904631547noreply@blogger.com